ESOPHAGEAL PERFORATION IN NEONATES: A REPORT OF 5 CASES FROM KUWAIT

Al-Sawan RMZ*, Soni AL*, Saleh QA*, Garg KC**

*Dept. of Pediatrics, **Dept. of Radiology, Farwaniya Hospital, Kuwait

 

Objective: Esophageal perforation is not an uncommon occurrence in Neonatal Intensive Care Units (NICU). The reported incidence is 1 in 5000 Livebirths (LB).Most of the cases occur in preterm and are traumatic in nature. Upper Esophageal Perforation (UEP) mimics Congenital Esophageal Atresia while Lower Esophageal Perforation (LEP) present as right sided pneumothorax and abnormal position of the Naso-Gastric Tube (NGT). Misdiagnosis can lead to unnecessary investigations and surgical interference. We report our experience of 5 such cases from Kuwait.

Methods: All cases admitted to NICU were carefully examined and investigated for any evidence of esophageal trauma. Liberal use of radiology done with especial reference to air-leak and position of the NGT. Surgical advice obtained wherever needed.

Results: Total 5 cases were diagnosed, 1 as UEP and 4 as LEP over a period of 5 years among 35700LB, giving an incidence of 1:7140LB. The UEP occurred immediately after resuscitation and presented as pneumo-mediastinum and failure to pass the NGT. Diagnosis was confirmed by contrast radiological study and baby was managed conservatively.The perforation was completely healed but baby later on died due to other problems. The 4 cases of LEP presented as sudden pneumothorax on right side and abnormal position of NGT on day3-5. All cases were managed successfully by conservative treatment; one died (unrelated toLEP), while remaining 3 done well till 1 year followup.

Conclusions: High index of suspicion is needed to diagnose Esophageal Perforation in the neonates. All NICU staff should be trained and retrained for gentle resuscitation methods to avoid this complication. Surgical interference is almost always unnecessary.

 

 
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